Feeling suspicious of others, having strange thoughts or feeling like hearing voices or seeing people no one else could see

Sometimes, children experience things that seem strange or unusual. They might hear voices that others can’t or see things that aren’t there. They might become suspicious of others for no reason or have beliefs that don’t seem real. They might also act in ways that are hard to understand. These experiences can be frightening for both the child and their caregivers and can occur suddenly or intensify over time.

This type of perception or thinking isn’t “lack of attention,” “lying,” or “imagination,” but rather a change in how the brain processes information. It’s important to remember that these problems are not the child’s fault and that help is available. Early intervention and support can make a big difference.

What is typical?

It’s common for young children to have active imaginations. They might have imaginary friends, talk to themselves, or believe in magical creatures. This is a normal part of development. As children grow, they learn to distinguish between fantasy and reality. Here’s what you might typically see:

• By age 5: Children engage in pretend play and may have imaginary friends.
• Between ages 6 and 8: Children start to understand the difference between real and pretend, but their imaginations are still active.
• By ages 9 and 11: Children’s thinking becomes more logical and realistic.
• By ages 12 and 14: Children’s thinking becomes more abstract and complex, but they generally understand reality.

The hope is that, as the brain matures, the child will be able to distinguish more clearly what is real and what is a figment of imagination.

When should I be concerned?

While imagination is normal, there are times when a child’s experiences may be cause for concern. In these situations, what the child or adolescent is experiencing is very real to them, even if it seems strange to others. If these experiences are frequent, distressing, or interfere with their daily life, it’s important to seek professional help.

Concerning signs may include:

• Hallucinations: The child sees, hears, smells, tastes, or feels things that others don’t. This might include seeing shadows or figures, hearing voices talking to them or to each other, or feeling things crawling on their skin.
• Delusions: The child has strong beliefs that are not based in reality. They might believe they have special powers, that others are trying to harm them, or that they are being controlled by outside forces.
• Rigid ideas with no basis in reality: Believing that there are hidden cameras in the home or that someone wants to harm the family, even when there is no proof of this.
• Disorganized thinking and speech: The child’s thoughts and speech may be jumbled, making it hard to understand them.
• Unusual or bizarre behavior: The child may act in ways that are strange or inappropriate for their age, such as talking to themselves in public, neglecting their hygiene, or having unusual rituals.
• Withdrawal and isolation: The child may withdraw from friends and family and lose interest in activities they used to enjoy.
• Changes in mood and behavior: The child may experience significant changes in their mood, such as becoming more anxious, irritable, or withdrawn.
• Difficulties with schoolwork: The child may have trouble concentrating, remembering things, or completing assignments.
• Changes in sleep patterns: The child may have difficulty falling asleep, staying asleep, or experiencing nightmares.

These experiences, when left untreated, often intensify and cause significant suffering. The sooner caregivers recognize that this is not just imagination, the better the chances of recovery and improvement with professional support.

What can I do to help?

If you are concerned about a child experiencing these difficulties, providing support and seeking professional help is crucial. Here are some things you can try:

1. Stay calm and listen: Provide a safe and non-judgmental space for the child to talk about their experiences.
2. Reassure and validate: Let the child know that you believe them and that you are there to support them. Phrases like, “I understand that this scares you. We’ll get through this together” can help.
3. Maintain a consistent routine: Regular sleep schedules, mealtimes, and activities can provide stability.
4. Encourage healthy habits: Promote good nutrition, exercise, and stress-reducing activities.
5. Limit exposure to stressors: Reduce exposure to stressful situations or triggers whenever possible.
6. Avoid challenging the child’s beliefs: Arguing or trying to convince the child that their experiences aren’t real can be counterproductive. Don’t tell them it’s a lie or that they’re just making it up, as this will only increase distrust.
7. Seek professional help: A mental health professional can provide an accurate assessment and recommend appropriate treatment.

Show the child that they are not alone. With appropriate intervention, these experiences can diminish, allowing them to resume daily coexistence and well-being.

What kind of professional support can I seek out?

If your child is experiencing these difficulties, it’s important to seek professional help immediately. Early intervention can significantly improve outcomes. Do not delay seeking help if you are concerned.

Talk to your child’s pediatricianor family doctor. They can refer you to other specialists, such as mental health professionals. Mental health professionals can help both the child and the caregivers. They can work with you to support your child at home and in therapy.

You can also find free support through the Unified Health System (SUS). Care often begins at your local Basic Health Unit (UBS). Other services include Child and Adolescent Psychosocial Care Centers (CAPS i), specialty centers, and clinics at university hospitals.